scholarly journals Knee Frontal-Plane Biomechanics in Adults With or Without Bone Marrow Edema-Like Lesions After Anterior Cruciate Ligament Injury

2017 ◽  
Vol 52 (6) ◽  
pp. 581-586 ◽  
Author(s):  
Abbey C. Thomas ◽  
Riann M. Palmieri-Smith
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Pain ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Frontal Plane ◽  
Acl Injury ◽  
Knee Adduction Moment ◽  
Control Group ◽  
Group Frequency ◽  
Anterior Cruciate

Context:  Lateral subchondral bone bruises (BBs) occur frequently with anterior cruciate ligament (ACL) injuries. These BBs are associated with pain during weight bearing, leading individuals to increase medial tibiofemoral loading to alleviate pain laterally. Increased medial tibiofemoral loading may precipitate the development or progression of posttraumatic osteoarthritis; however, no in vivo biomechanical data exist to confirm that lateral BBs increase medial tibiofemoral loading as measured by the external knee-adduction moment (KAM). Objective:  To determine whether lateral BBs after ACL injury increase the external KAM during walking. Design:  Descriptive laboratory study. Setting:  University research laboratory. Patients or Other Participants:  Eleven volunteers with an ACL injury (age = 20.36 ± 4.03 years, height = 177.60 ± 8.59 cm, mass = 79.70 ± 16.33 kg), 12 with an ACL injury and a lateral BB (ACL + BB; age = 19.25 ± 5.58 years, height = 170.71 ± 9.40 cm, mass = 66.79 ± 11.91 kg), and 12 healthy controls (age = 19.67 ± 5.19 years, height = 173.29 ± 11.58 cm, mass = 67.07 ± 11.25 kg) participated. Intervention(s):  We recorded peak KAM during 3 walking trials (1.1 ± 0.6 m/s) in which participants walked over a force platform located in the field of view of a motion-capture system. Main Outcome Measure(s):  Peak KAM was calculated during the first half of stance using standard inverse-dynamics analysis, averaged across trials, and examined via 1-way analysis of variance. Knee pain and function were determined from the International Knee Documentation Committee Subjective Knee Evaluation Form and compared among groups via the Kruskal-Wallis test. Results:  Peak KAM did not differ among groups (ACL injury = 0.14 ± 0.07 Nm·kg−1·m−1, ACL + BB = 0.21 ± 0.08 Nm·kg−1·m−1, control = 0.20 ± 0.08 Nm·kg−1·m−1; F2,35 = 3.243, P = .052). Knee-pain frequency and severity were greater in the ACL-injury (frequency = 2.55 ± 1.81, severity = 3.36 ± 1.75; both P < .001) and ACL + BB (frequency = 3.58 ± 2.81, severity = 4.08 ± 3.20; both P < .001) groups than in the control group (frequency = 0.00 ± 0.00, severity = 0.00 ± 0.00). Knee function was greater in the control group (100.00 ± 0.00) than in the ACL-injury (59.35 ± 17.31; P < .001) and ACL + BB (46.46 ± 25.85; P < .001) groups. Conclusions:  The ACL + BB groups did not walk with a greater external KAM than the ACL-injury or control groups. Thus, lateral tibiofemoral BB did not influence knee frontal-plane loading after ACL injury.

scholarly journals USE CAUTION WHEN ASSESSING PRE-OPERATIVE LEG LENGTH DISCREPANCY IN PEDIATRIC PATIENTS WITH ANTERIOR CRUCIATE LIGAMENT INJURIES

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0028
Author(s):  
Lindsay M. Schlichte ◽  
Peter D. Fabricant ◽  
Christine Goodbody ◽  
Daniel W. Green
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Acl Injury ◽  
Leg Length ◽  
Full Extension ◽  
X Ray ◽  
Length Discrepancy ◽  
Anterior Cruciate

Background: Pre- and post-operative standing hip to ankle radiography is critical for monitoring potential post-operative growth arrest and resultant length and angular deformities after pediatric anterior cruciate ligament (ACL) reconstruction. During acquisition of pre-operative standing alignment radiographs, it is possible that patients are lacking full extension, not weight bearing comfortably, or leaning resulting in inaccurate measurements. Purpose: This study aims to assess both pre- and post-operative radiographic measurements to assess if the standing pre-operative x-ray is a accurate and reliable source for baseline measurements. Methods: We retrospectively reviewed prospectively collected pre-operative and first post-operative full-length hip-to-ankle radiographs in a cohort of skeletally immature athletes who presented with an acute ACL injury and underwent subsequent surgical reconstruction. Initially, leg length discrepancy for 25 patients was measured by 3 orthopedic surgeons (top of femoral head to center of tibial plafond). The intraclass correlation was almost perfect (ICC (2,1) = .996) therefore, 1 surgeon measured the remaining 94 radiographs. Measurements for both the injured and uninjured legs were obtained for comparison and surgeons were blinded to the injured side. Results: A total of 119 pediatric patients (mean age 13.4, range 7-14 years) were included (83 males and 36 females). Patient were categorized as either having ≥5mm, ≥10mm, or ≥15mm LLD on pre-operative standing x-ray. Sixty-two patients (52%) were found to have a pre-operative LLD ≥ 5mm. Forty-one (66%) of these patients tore their ACL on the limb measuring shorter. At 6 month post-operative standing x-ray, 35 patients (56%) resolved to ≤5mm LLD. Eighteen patients had a pre-operative LLD of ≥ 10mm. At 6 month post-operative standing x-ray, 13 (72%) patients resolved to ≤5mm LLD. Five patients had a pre-operative LLD of ≥ 15mm. At 6 month post-operative standing x-ray, 4 (80%) resolved ≤5mm. All patients with a pre-operative LLD of ≥ 13mm had sustained an ACL injury on the limb measuring shorter Conclusion: Of the pediatric ACL patients initially presenting with a pre-operative LLD of ≥ 10mm, 72% demonstrated apparent correction of their LLD on their 6 month standing x-ray. This high rate of LLD pre-operatively but not post operatively calls into question the accuracy of pre-operative standing alignment radiographs for patients after an ACL tear. Surgeons and radiology technicians should be aware of injured patients potentially lacking full extension, leaning, or not weight bearing comfortably, and should consider delaying preoperative radiographic length and alignment analysis until after the patient is able to fully straighten the injured knee and weight bear comfortably.

scholarly journals Anterior Cruciate Ligament Injury

2014 ◽  
Vol 2 (12_suppl4) ◽  
pp. 2325967114S0025
Author(s):  
Tomas Vilaseca ◽  
Jorge Chahla ◽  
Gustavo Gomez Rodriguez ◽  
Damián Arroquy ◽  
Gonzalo Perez Herrera ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Internal Rotation ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
T Test ◽  
Control Group ◽  
Recreational Athletes ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Knee Pathology

Objectives: The objective of this study was to analyze whether it is more frequent the presence of a decreased range of motion in the hips of recreational athletes with primary injury of the anterior cruciate ligament (ACL) than in a control group of volunteers without knee pathology. Methods: We included prospectively recreational athletes between 18 and 40 years with an acute ACL injury between January 2011 and January 2013. They were compared with a control group of volunteers recreational athletes without lower limb pathology and in the same range of age. The internal and external rotations passively prior to the point at which the pelvis movement contributes were observed. The results were statistically analyzed using t test for related samples to the hips of patients with ACL injury and t test for independent variables for comparison with the control group. Results: 48 patients with ACL injury and 53 healthy volunteers were evaluated. The ACL group was composed of 32 males and 16 females with an average age of 29.3 years. In the control group 26 males and 27 females were studied with a mean age of 26.6 years. Internal (IR) and external (ER) rotation in the LCA group was 22,9º and 55,5º respectively in the ipsilateral hip and 27,9º and 57,7º in the contralateral. In the control group a 35,9º of IR and 55,2º of ER was observed. The analysis showed an association between ACL injury and hypomotility of the hip further expense of a decrease in internal rotation. The analysis showed an association between ACL injury and hypomotility of the hip at the expense to a greater decrease in internal rotation. Conclusion: We found a statistically significant difference in the mobility of the hips in patients with ACL injury predominantly due to internal rotation, pattern that allows us to interpret this injury not only as an intrinsic etiology of the knee but also of the adjacent joints. We consider very importance to incorporate prevention activities and screening of risk factors regarding to at least high performance athletes.

scholarly journals Patellar Tendon Quality and Knee Symptoms in Male Athletes Before the Anterior Cruciate Ligament Reconstruction

2020 ◽  
Author(s):  
Carla Soncino Pereira ◽  
Jasenko Klauznicer ◽  
Sean McAuliffe ◽  
Rodney Whiteley ◽  
Taija Juutinen Finni
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Knee Pain ◽  
Tissue Characterization ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Ultrasound Tissue Characterization ◽  
Anterior Cruciate ◽  
The Impact

Abstract Background: It is unknown if the quality of the patellar tendon is affected by an anterior cruciate ligament (ACL) injury. ACL deficient patients (ACL-D) have shown to have knee pain, quadriceps weakness and reduced knee function. Ultrasound tissue characterization (UTC) has been used to assess the quality of tendons by quantifying the proportion of echo-types using a numerical grading system from best to worst (I-IV). The primary aims of this cross-sectional study were to investigate the patellar tendon quality in athletes with unilateral ACL injuries, and to compare them to asymptomatic control tendons. The secondary aims were to assess the impact of anterior knee pain (AKP) in the patellar tendons of ACL-D, and to explore possible correlations between tendon quality and knee pain, knee extensor strength and time from ACL injury. Methods: UTC was used to scan both patellar tendons of 81 ACL-D athletes and 20 control tendons. Echo-types distribution was calculated to compare the quality between limbs of ACL-D and control tendons; and to compare ACL-D with AKP, other knee pain, and without pain. Associations between the variables of tendon quality and knee symptoms were explored. Results: No difference in tendon quality was found between limbs of ACL-D. Both tendons of ACL-D displayed more echo-type II at the patellar apex, and same or less echo-types III and IV than controls. The proximal half of the control tendons displayed better quality than the distal half. ACL-D knees with pain displayed less extensor strength, however, in addition to the lack of difference in tendon quality regardless of the presence and location of pain, there was no meaningful association between pain, extensor strength and tendon quality. Nevertheless, there were weak to moderate associations between tendon quality and time from ACL injury. Conclusion: Despite the ACL injury, there is no difference in tendon quality between ACL-D limbs, or when subgrouping ACL-D tendons by presence and location of knee pain. Different areas of the patellar tendon may present different characteristics that might be related to training. Tendon quality is better if a person has longer time from injury.

Meniscal Suture Influence on Driving Ability 6 Weeks after Anterior Cruciate Ligament Reconstruction with Hamstring Autograft

2021 ◽  
Author(s):  
Maria Perez-Mozas ◽  
Jesus Payo-Ollero ◽  
Veronica Montiel ◽  
Juan Ramon Valenti-Nin ◽  
Andres Valenti-Azcarate
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Driving Performance ◽  
Driving Ability ◽  
Control Group ◽  
Hamstring Autograft ◽  
Meniscal Suture ◽  
Healthy Control ◽  
Anterior Cruciate

AbstractThe purpose of this study was to determine if driving ability 6 weeks after anterior cruciate ligament (ACL) reconstruction is affected by the addition of a meniscal suture. It was also hypothesized that no differences in the driving performance would be found between right or left knee surgery subgroups. A total of 82 people participated in this prospective cohort study: 36 healthy controls, 26 patients undergoing isolated ACL (iACL) reconstruction with hamstring autograft, and 20 patients undergoing ACL and meniscal suture (ACL-MS) reconstruction. ACL-MS group followed a weight-bearing and movement restriction protocol during the first 2 postoperative weeks, whereas patients undergoing iACL could start range-of-motion exercises and full weight-bearing ambulation on the first postoperative day. A driving simulator that reproduced real-life driving conditions was used to evaluate driving ability. The software analyzed multiple driving and braking variables. Driving performance in the sixth postoperative week was compared with that of a healthy control group. Subgroup analysis considering additional procedures (iACL, ACL-MS) and the side of the operated knee (right, left) was also performed. No statistically significant differences were found in the demographic characteristics nor in the driving performance (collisions, p = 0.897; sidewalk invasions, p = 0.749; pedestrian impact, p = 0.983) between iACL, ACL-MS, and control groups. No statistically significant differences were found in right–left subgroup analysis. The results of the present study show that patients in their sixth postoperative week after right or left ACL reconstruction showed similar driving performance as compared with a healthy control group, regardless of associating or not a meniscal suture, suggesting it is safe to resume driving 6 weeks after the mentioned surgeries.

scholarly journals Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

2017 ◽  
Vol 52 (6) ◽  
pp. 575-580 ◽  
Author(s):  
Jeffrey B. Driban ◽  
Stefan Lohmander ◽  
Richard B. Frobell
Keyword(s):  
Bone Marrow ◽  
Anterior Cruciate Ligament ◽  
Knee Pain ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Magnetic Resonance Images ◽  
Bone Marrow Lesion ◽  
Bone Bruise ◽  
Cross Sectional ◽  
Anterior Cruciate

Context:  After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear. Objective:  To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury. Design:  Cross-sectional exploratory analysis of a randomized clinical trial. Setting:  Orthopaedic departments at 2 hospitals in Sweden. Patients or Other Participants:  As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age = 26 ± 5 years, height = 1.8 ± 0.1 m, weight = 76 ± 13 kg) with an ACL tear were studied. Main Outcome Measure(s):  The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations. Results:  Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (β = −0.09, P = .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (β = –0.46, P = .02), whereas no association was found for those with a depression fracture (β = 0.0, P = .96). Larger medial (β = –0.48, P = .02) but not lateral (β = –0.03, P = .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms. Conclusions:  We confirmed the absence of relationships between whole-knee BML volume and pain and symptoms within 4 weeks of ACL injury. Our findings extend previous reports in identifying weak associations between larger BML volume in the medial compartment and greater pain and between BML volume and greater pain among those without a depression fracture.

scholarly journals Analysis of Internal Knee Forces Allows for the Prediction of Rupture Events in a Clinically Relevant Model of Anterior Cruciate Ligament Injuries

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989375 ◽  
Author(s):  
Ryo Ueno ◽  
Alessandro Navacchia ◽  
Nathaniel A. Bates ◽  
Nathan D. Schilaty ◽  
Aaron J. Krych ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Anterior Cruciate Ligament ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Knee Adduction Moment ◽  
Mechanical Impact ◽  
Internal Forces ◽  
Anterior Cruciate

Background: A recently developed mechanical impact simulator induced an anterior cruciate ligament (ACL) rupture via the application of a combination of inverse dynamics–based knee abduction moment (KAM), anterior tibial shear force (ATS), and internal tibial rotation moment with impulsive compression in a cohort of cadaveric limbs. However, there remains an opportunity to further define the interaction of internal forces and moments at the knee and their respective influence on injury events. Purpose: To identify the influence of internal knee loads on an ACL injury event using a cadaveric impact simulator. Study Design: Controlled laboratory study. Methods: Drop-landing simulations were performed and analyzed on 30 fresh-frozen cadaveric knees with a validated mechanical impact simulator. Internal forces and moments at the knee joint center were calculated using data from a 6-axis load cell recorded on the femur during testing. Kinetic data from a total of 1083 trials that included 30 ACL injury trials were used as inputs for principal component (PC) analysis to identify the most critical features of loading waveforms. Logistic regression analysis with a stepwise selection was used to select the PCs that predicted an ACL injury. Injurious waveforms were reconstructed with selected PCs in logistic regression analysis. Results: A total of 3 PCs were selected in logistic regression analysis that developed a significant model ( P < .001). The external loading of KAM was highly correlated with PC1 (ρ < –0.8; P < .001), which explained the majority (>69%) of the injurious waveforms reconstructed with the 3 selected PCs. The injurious waveforms demonstrated a larger internal knee adduction moment and lateral tibial force. After the ACL was ruptured, decreased posterior tibial force was observed in injury trials. Conclusion: These findings give us a better understanding of ACL injury mechanisms using 6-axis kinetics from an in vitro simulator. An ACL rupture was correlated with an internal knee adduction moment (external KAM) and was augmented by ATS and lateral tibial force induced by an impact, which distorted the ACL insertion orientation. Clinical Relevance: The ACL injury mechanism explained in this study may help target injury prevention programs to decrease injurious knee loading (KAM, ATS, and lateral tibial force) during landing tasks.

scholarly journals Correlation of Femoral Trochlear Dysplasia With Anterior Cruciate Ligament Injury in Skeletally Immature Patients

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110226
Author(s):  
Yoon Hae Kwak ◽  
Ji-Hoon Nam ◽  
Yong-Gon Koh ◽  
Kyoung-Tak Kang
Keyword(s):  
Anterior Cruciate Ligament ◽  
Trochlear Dysplasia ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Type A ◽  
Ligament Injury ◽  
Control Group ◽  
Injury Group ◽  
Anterior Cruciate ◽  
Skeletal Immaturity

Background: Reports of anterior cruciate ligament (ACL) injury in patients with skeletal immaturity have been increasing. Variations in knee joint anatomy have been linked to ACL injury risk factors. Purpose: To identify associations between ACL injury, patella alta, and femoral trochlear dysplasia in patients with skeletal immaturity by using magnetic resonance imaging (MRI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: This retrospective study included 231 patients with skeletal immaturity—116 with acute complete noncontact ACL injury and 115 without ACL injury (controls)—who underwent knee MRI. Cases of femoral trochlear dysplasia were divided into 4 types according to the Dejour classification scheme. Patellar height and patellar tendon length were measured via sagittal MRI, and the Insall-Salvati ratio (ISR) was calculated. Results: In the ACL injury group, 56 (48.3%) knees exhibited trochlear dysplasia, including 51 (91.1%) that were Dejour type A; and in the control group, 12 (10.4%) knees exhibited trochlear dysplasia, 12 (100%) Dejour type A. The prevalence of femoral trochlear dysplasia was significantly higher in the ACL injury group than in the control group ( P < .001). The ISR was not significantly different between the ACL injury and control groups (0.9 ± 0.2 vs 1 ± 0.2 mm; P = .16). The correlation between ISR >1.2 and presence of ACL injury was not significant. Conclusion: Femoral trochlear dysplasia was associated with ACL injury in patients with skeletal immaturity. In particular, Dejour type A femoral trochlear dysplasia was correlated with ACL injury patients with skeletal immaturity. Also, the possibility of ACL damage exists in patients with skeletal immaturity and femoral trochlear dysplasia.

scholarly journals Mechanism of Activating the Proprioceptive NT-3/TrkC Signalling Pathway by Reverse Intervention for the Anterior Cruciate Ligament–Hamstring Reflex Arc with Electroacupuncture

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Lei Zhang ◽  
Yan Zeng ◽  
Ji Qi ◽  
Taiyuan Guan ◽  
Xin Zhou ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Group Intervention ◽  
Cruciate Ligament ◽  
Quantitative Polymerase Chain Reaction ◽  
Acl Injury ◽  
Signalling Pathway ◽  
Knee Joints ◽  
Control Group ◽  
Model Control ◽  
Anterior Cruciate

The anterior cruciate ligament (ACL) is an important structure maintaining stability of the knee joints. Deficits in physical stability and the proprioceptive capabilities of the knee joints are observed, when the ACL is damaged. Additionally, a unilateral ACL injury can affect bilateral knee proprioception; therefore, proprioception of the ACL may play a key role in stability. Electroacupuncture therapy has a definite effect nerve regeneration. In this study, cynomolgus monkeys were randomly divided into 4 groups: the model control group, intervention of the injured knee with electroacupuncture (IIKE) group, intervention of the bilateral knees with electroacupuncture (IBKE) group, and the blank control group. The unilateral ACL injury model was developed in IIKE and IBKE groups; acupuncture points around the knees underwent intervention similarly in the IIKE and IBKE groups. Then, mRNA and protein expressions of NT-3 and TrkC in the dorsal root ganglion and of growth-associated protein-43 in the ACL increased according to reverse-transcription quantitative polymerase chain reaction and Western blotting results. Decreased incubations and increased amplitudes were found for somatosensory-evoked potentials and motor nerve conduction velocity. The finding indicates that electroacupuncture may play an important role in the recovery of proprioception in the ACL by activating the NT-3/TrkC signalling pathway.

scholarly journals The underlying mechanism of partial anterior cruciate ligament injuries to the meniscus of knee joint in rabbit models

2020 ◽  
Author(s):  
Dalin Wang ◽  
Zhe Wang ◽  
Mingcheng Li ◽  
Songbao Xu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Underlying Mechanism ◽  
Joint Fluid ◽  
Control Group ◽  
Rabbit Knee ◽  
Significant Difference ◽  
Anterior Cruciate

Abstract Background The diagnosis, treatment and efficacy evaluation of anterior cruciate ligament (ACL) remains controversial. This research aims to investigate the underlying mechanism of partial ACL injuries to the meniscus degeneration in rabbit knee. Methods Sixty New Zealand, white rabbits were randomly divided into three groups: the anteromedial bundle (AMB) splitting, the posterolateral bundle (PLB) splitting and a control group. Finally, eight rabbits were sampled randomly on the second, fourth and eighth weeks respectively. We observed the typical form of the meniscus through HE staining. Expressions of inflammatory factors including interleukin-1β (IL-1β) and IL-17 in the knee joint fluid were determined by means of an ELISA. Analysis of the mRNA expressions of MMP-13 was performed to evaluate the inflammatory mediators in the pathogenesis of the meniscus. Results HE staining results showed that the surface was rough and the tissues were loose displaying collagen fibers of varying thickness. Both IL-1β and IL-17 in the synovial fluid, and the positive rate of MMP-13 in addition to MMP-13 mRNA showed a demonstrable increase treads from the 2nd to the 8th week. The significant difference was found ( P <0.05) compared to the control group. Conclusion Our findings illustrated that the elevated levels of IL-1β and IL-17, along with increased MMP13 expression, resulting in meniscus degradation in the rabbit knee joint model with partial ACL injury. When the partial ACL injury on the different bundles occurred, the reconstruction of the reserved AMB or PLB must be operated on time due to uncertainty of conservative treatment.

Change in KOOS and WOMAC Scores in a Young Athletic Population With and Without Anterior Cruciate Ligament Injury

2018 ◽  
Vol 46 (7) ◽  
pp. 1606-1616 ◽  
Author(s):  
Ivan J. Antosh ◽  
Steven J. Svoboda ◽  
Karen Y. Peck ◽  
E’Stephan J. Garcia ◽  
Kenneth L. Cameron
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cohort Study ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Control Group ◽  
First Year ◽  
Inclusion Criteria ◽  
First Year Students ◽  
Anterior Cruciate

Background: Several studies have examined changes in patient-reported outcome measures (PROMs) after anterior cruciate ligament (ACL) injury, but no studies to date have prospectively evaluated changes from preinjury baseline through injury and follow-up among ACL-injured patients compared to the baseline and follow-up changes of uninjured patients. Purpose: To examine changes in PROMs over time from preinjury baseline to at least 2 years after ACL reconstruction and to compare these changes with those of an uninjured control group having similar physical activity requirements. Study Design: Cohort study; Level of evidence, 2. Methods: The authors conducted a prospective cohort study with a nested case-control analysis at a US service academy. All incoming first year students were recruited to participate in this study. Consenting participants completed a baseline questionnaire that included the KOOS (Knee injury and Osteoarthritis Outcome Score), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and MARS (Marx Activity Rating Scale). Participants who sustained a subsequent ACL injury completed assessments at the time of surgery and at 6, 12, and 24 months after surgery. Healthy participants were recruited to repeat the baseline assessments within 1 year of graduation. Inter- and intragroup differences at these time points were evaluated with dependent and independent t tests, respectively. We also compared these results with established minimum clinically important difference (MCID) values. Results: Of 1268 first year students entering the academy, 1005 with no previous injuries consented to participate in this study (82% male, mean ± SD age 19 ± 1 years). Of those enrolled, 30 suffered an ACL injury and met the inclusion criteria for this study. Ninety uninjured control students who met the inclusion criteria completed follow-up assessments. There were statistically significant differences across all KOOS and WOMAC subscales between ACL-injured group and uninjured group at the time of the final follow-up assessment. Four KOOS subscales (Pain, Symptoms, Sports and Recreation Function, and Knee-Related Quality of Life) and the WOMAC Stiffness subscale demonstrated >8-point differences between groups, which exceeded the established MCID for these instruments. There were no significant differences between the ACL-injured group and uninjured groups noted for the MARS ( P = .635). At the time of final follow-up, the ACL-injured group also reported significant deficits on the WOMAC Stiffness subscale ( P = .032), the MARS ( P = .030), and all KOOS subscales, with the exception of Functional Activities of Daily Living, as compared with their preinjury baseline scores. These deficits exceeded the established MCID values for 3 KOOS subscales and the MARS. Conclusion: Patients with ACL injuries reported significant deficits on PROMs at least 2 years after surgical reconstruction in relation to preinjury baseline scores and an uninjured control group. Many of these deficits exceeded established MCID values.

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